Fellowship Training Program in Digestive Diseases and Hepatology Stony Brook University Medical Center Northport Veterans Affairs Medical Center

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1 Fellowship Training Program in Digestive Diseases and Hepatology Stony Brook University Medical Center Northport Veterans Affairs Medical Center Inpatient GI Curriculum Goals and Objectives Revised December 21, 2015 Edward Sun, M.D. Clinical Assistant Professor Asim Khokhar, M.D. Clinical Assistant Professor Fellowship Program Director

2 GI Inpatient Service Curriculum for Year I and Year II. Please see the Biliary/Advanced Inpatient Rotation curriculum for Year III Fellows. Educational Goals: The GI Inpatient Service teaches Fellows to manage hospitalized patients with gastrointestinal diseases. Training is conducted at both Stony Brook University Medical Center (SBMC) and at the Northport Veterans Affairs Medical Center (VAMC). Fellows will learn to formulate comprehensive differential diagnoses and recommend appropriate diagnostic studies and therapeutic measures. Fellows will participate in and perform procedures for their inpatients as needed. Fellows will care for patients with a wide range of clinical problems in all stages of illness providing a broad spectrum and depth of diseases in Gastroenterology and Hepatology. Increasing degrees of independence will be given to the Fellows as they progress through their training years. The educational purpose of the inpatient consult service is to help Fellows gain the medical knowledge, procedural, and interpersonal and communication skills necessary to functioning as an effective Gastroenterology consultant. Objectives: Fellows will develop proficiency in all aspects of caring for hospitalized patients with gastrointestinal diseases. Competency-based objectives are listed in this curriculum for each of the first two years of fellowship training. Please see the Hepato-biliary GI Curriculum for Year III Fellows. Evaluations will be performed by the supervising Attending physician at the conclusion of each rotation. Feedback will be expected to be given to the Fellows in face-to-face interactions at the discretion of the supervising Attending. All evaluations will be reviewed by the Program director and discussed with Fellows during individual meetings on a bi-annual basis. The following are the goals and objectives for each competency at each level of training for the GI inpatient service.

3 Year I Fellow GI Inpatient Curriculum Goals: By the end of Year I, Fellows will be proficient at receiving, triaging, and managing GI consultations from other hospital services. They will be expected to accurately assess GI Inpatient problems, formulate and execute treatment plans with the guidance of the supervising Attending, and communicate these plans with the consulting services. Year I Fellows will also begin to develop basic procedural competencies in upper endoscopy and colonoscopy. Year I Fellows will also be expected to master the indications for endoscopic evaluation and develop a basic sense for the therapeutic tools available. Patient Care Objectives: Obtain accurate histories and perform comprehensive physical examinations. Present information concisely with an initial assessment and plan. With the supervising Attending physician, formulate and execute assessments and recommendations for the consulting services. Obtain consent for procedures. Coordinate with the endoscopy unit to book inpatient procedures in a timely manner. Colonoscopy: by the completion of Year I, a Fellow is expected to perform a colonoscopy to the cecum with limited assistance. Esophagogastroduodenoscopy: by the completion of Year I, a Fellow is expected to perform an upper endoscopy to the second portion of the duodenum. Year I Fellows are expected to be familiar with the use of wireless capsule endoscopy. Provide safe and compassionate care to hospitalized patients. Educate patients on their conditions as well as the rationale for diagnostic and therapeutic recommendations. Medical Knowledge Objectives: Year I Fellows are expected to attend and participate in all teaching conferences to learn the pathophysiology, epidemiology, diagnosis, and evolving management of both common and uncommon inpatient gastrointestinal diseases. Fellows are expected to apply this knowledge to patient care. Year I Fellows are expected to become proficient in working up such symptoms and conditions as abdominal pain, constipation, diarrhea, dysphagia, anemia, and abnormal liver function tests. Common diagnoses include upper and lower GI bleeding, GI infections, ileus, drug-induced liver injury, and cirrhosis. Achieve an average or above-average percentile score (comparable to Year I national scores) on the Gastroenterology Training Examination (GTE). By the completion of Year I, Fellows are expected to have passed the Internal Medicine Board Examination.

4 Practice-Based Learning Objectives: Year I Fellows are expected to begin to investigate and evaluate their practices, appraising and assimilating scientific evidence in order to improve their patient care practices. Participate in Morbidity & Mortality conferences, reviewing inpatient cases with adverse events. Interpersonal and Communication Skills Objectives: Year I Fellows are expected to interview patients and family members with patience and compassion. Year I Fellows are expected to develop interpersonal communication skills that result in effective information exchange with patients, family members, and professional associates. Fellows are expected to convey endoscopy results and post-procedural recommendations to consulting teams. Professionalism Objectives: Fellows must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Learn to interact collegially with co-fellows and other healthcare professionals. Learn to practice appropriate and unbiased prescribing habits. Answer patient calls when on first-call with patience, compassion, and conduct representative of the Gastroenterology Department at Stony Brook. Participate in program development meetings when requested. Systems-Based Practice Objectives: Develop a sense of awareness to the larger context and system of health care and to utilize system resources to provide quality care to our inpatients. Understand and work effectively within the infrastructure of Stony Brook Hospital. Understand and practice proper documentation and diagnosis coding (e.g. Provations). Participate in endoscopy in-services and training to become comfortable with standard operating procedures in the Endoscopy suite. Participate in quality improvement projects. Attend and participate in national Gastroenterology and Hepatology conferences (e.g. ACG, DDW, or AASLD).

5 Year II Fellow Inpatient GI Curriculum Goals: A Year II Fellow will learn to care for a larger volume of patients and teach textbook and evidence-based concepts in gastroenterology and hepatology to medical students, house-staff, and other trainees. Fellows by the end of their second year of training will be expected to be able to independently perform diagnostic upper endoscopies and colonoscopies, and to begin to develop proficiency in performing therapeutic maneuvers. Patient Care Objectives: In addition to mastering Year I Patient Care objectives, Year II Fellows will be expected to mentor and provide constructive criticism to the patient care practices of Year I Fellows. In the first three months of the academic year, Year II Fellows will supervise Year I Fellows while carrying their own patient load. By the completion of Year II, Fellows will be expected to be able to complete colonoscopy to the cecum independently as well as develop familiarity with endoscopic maneuvers such as snare polypectomy and biopsies, as well as hemostasis of bleeding vessels with clipping or thermal therapy. By the completion of Year II, Fellows will be expected to perform upper endoscopy to the second part of the duodenum independently and develop familiarity with endoscopic maneuvers such as banding and sclerosis of esophageal varices and hemostasis of bleeding vessels with clipping or thermal therapy with limited assistance. Year II Fellows will be expected to be able to manage their patients with limited Attending assistance. Year II Fellows are expected to provide inpatient care that is safe and compassionate. Medical Knowledge Objectives: In addition to mastering Year I Medical Knowledge objectives, Year II Fellows will assume leadership roles at core conferences and teaching rounds regarding the pathophysiology, epidemiology, diagnosis, and evolving management of both common and uncommon inpatient gastrointestinal diseases. Year II Fellows are expected to give lectures to medical students, house-staff, and other trainees in such forums as the Internal Medicine Noon conference and Wednesday Academic Lecture Days. Achieve an average or above-average percentile score (comparable to Year II national scores) on the Gastroenterology Training Examination (GTE).

6 Practice-Based Learning Objectives: In addition to mastering Year I Practice-based learning objectives, Year II Fellows are expected to participate in program improvement committees and project groups. Participate in out-come driven quality improvement projects. Provide constructive feedback to co-fellows and year I Fellows. Participate in Morbidity & Mortality conferences, reviewing inpatient cases with adverse events. Participate in the Program Evaluation Committee (PEC) if selected. Interpersonal and Communication Skills Objectives: In addition to mastering Year I Interpersonal and Communication Skills objectives, Year II Fellows are expected to counsel patients and their family members patiently and with compassion, presenting information and therapeutic options in a clear and objective manner. Year II Fellows will continue to develop the skills to communicate effectively with staff, cofellows, Attending gastroenterologists, consulting house-staff and physicians, and other consultants. Professionalism Objectives: In addition to mastering Year I Professionalism Objectives, Year II Fellows are expected to act as role models and mentors for medical students, house-staff, and Year I Fellows in professional conduct. Continue to practice ethical principles with regard to patient care and confidentiality. Continue to develop a greater awareness of cultural, age, gender, and disability issues. Systems-based Practice Objectives: In addition to mastering Year I Systems-based Practice objectives, Year II Fellows will develop a greater sense for how the Inpatient Gastroenterology Service functions in relation to greater hospital functions in practicing cost-effective quality care. Year II Fellows will be expected to develop and participate in quality improvement initiatives. Attend and participate in national Gastroenterology and Hepatology conferences (e.g. ACG, DDW, or AASLD).